NSAID's

Question 1

What are NSAID’s

Answer 1

-non-steroidal inflammatory drugs

Question 2

Describe how pain sensation is felt ( eg right hand )

Answer 2

• Afferent nerve is stimulated by mediators of inflammation or physical damage
• nerve impulse taken to 2nd order neuron and goes to left spinothalamic track up stem and to thalamus
• synapse with 3rd order neuron which propagates to somatosensory cortex and that discerns which part is injured and pain perceived

Question 3

How does pain aid in inflammation

Answer 3

-stimulated afferent nerves release Substance P and CGRP which enhance inflammation response

Question 4

How do inflammation mediators cause pain

List the mediators and the receptors they bind to

Answer 4

/they bind to noiceptors on afferent nerve nearby depolarizing the neuron

• bradykirin B2
• prostaglandin : prostanoid receptors

Question 5

How are mediators for inflammation made by the body

Answer 5

• damaged membrane releases phospholipase AC which converts phospholipid into arachadonic acid
• LPO converts the acid into leukotrines
• COX 1 and 2 convert it into prostaglandins , thromboxane and prostacyclin

Question 6

Diff of Cycloxygenase 1 and 2

Answer 6

• secreted continuously and is for normal homeostasis

- secreted only during inflammation and is for inflammation response

Question 7

What is the MOD of action of NSAID’s

Answer 7

-block COX enzymes and there will be no production of inflammation mediators ( prostaglandins )

Question 8

3 types of nsaids and examples

Answer 8

1 Cox 1 selective : aspirin

2 non-selective : ibuprofen , paracetamol

3 Cox 2 selective : celecoxib

Question 9

4 Aim or responses of nsaids

Answer 9

• anti inflammatory
• antipyretic : reduces fever
• analgesic : reliefs pain
• anti platelets : stop clotting of blood

Question 10

What’s does Cox 1 do. It’s effects

Answer 10

/produces prostaglandins which have

• inflammation effect
• pain
• swelling
• aid in renal flow via constriction
• aid in secretion of gastric muscus

/converts arachadonic acid into thromboxane which aids in blood clotting

Question 11

What does Cox 2 do. It’s effects

Answer 11

/ converts arachadonic acid into prostaglandins

• inflammation
• pain
• bronchodilaton
• swelling
• inhibits blood clot

Question 12

What does LPO do and it’s effects

Answer 12

-converts arachadonic acid into leukotrines
1 increase respiratory tract mucus production
2 bronchospasm
3 inflammation response

Question 13

Effects of inhibiting Cox 1

Answer 13

• blot does not clot ( excessive hemorrhage )
• gastric ulcers
• renal failure
• inflammation , pain , swelling and fever subside

Question 14

Effects of inhibiting Cox 2

Answer 14

• blood easily clots ( stroke infarction )

- bronchospasm

Question 15

What makes prostacyclin , it’s function and effects if deficient

Answer 15

• made by endothelial cells
• causes vasodilation to inhibit blood clot

-excessive blood clot ( stroke , infarction )

Question 16

2 other drugs to never take with nsaids

Answer 16

• diuretics

- ACEI

Question 17

How do nsaids aid in renal failure

Answer 17

-causes renal arteriole to dilate and important for glomerular filtration

Question 18

How does Cox 2 cause rheumatoid arthritis

Answer 18

-it aids in inflammatory response due to immune cells attacking the bodies own joints

Question 19

What’s the effect of aspirin irreversibly inhibiting Cox 1

Answer 19

-platelets are irreversibly inhibited and since they have no nucleus they can’t make more and will have to wait for turnover

Question 20

What do leukotrines lead to and how to stop it

Answer 20

• it leads to asthma

- use leukotrine receptor antagonists to stop leukotrines from binding

Question 21

Why suppress pain and fever with nsaids

Answer 21

• may produce shock , interfere with quality of life , may frighten the patient
• incapacitated people , inactivates metabolism of important processes

Question 22

How do IL-1 , TNF-a and prostaglandins cause fever

What won’t nsaids reduce

Answer 22

-they cause the hypothalamus to release PGE’s which cause body temperature to increase

/normal temp or elevated temp of heat stroke

Question 23

What is contraindicated and indications

Answer 23

/reasons to not take a specific drug due to the effects

-reasons to take a drug due to the benefits

Question 24

Why not use aspirin in gout patients

Answer 24

-aspirin increases Uric acid conc in urine which may be crystallized and deposit in joints

Question 25

Why not use aspirin in kids under 12

Answer 25

-if recovering from viral infection will cause brain swelling leading to Reye’s syndrome

Question 26

Why not use aspirin in asthma patients

Answer 26

-Cox 1 is blocked , no thromboxane , wc causes excess of pro/inflammatory leukotrines causing asthma

Question 27

What is topical preparation and it’s diff to oral

Answer 27

-medication applied to the dermis

• slower absorption ( 10 times slower )
• blood levels 15% lower than oral
• 4-6 mm dermis conc high
• 25mm dermis conc low

Question 28

Why not use aspirin in pregnancy

Aspirin in ductus sinuses

Answer 28

• increase onset of labour
• pulmonary hypertension in kids

-closure of patent ductus sinuses

Question 29

Pain and opioid scale

Answer 29

1 mild - non opioids

2 moderate - weak opioids and non opioids

3 severe - strong opioids and non opioids

Question 30

Initial dose , subsequent and max of ibuprofen

Answer 30

• 400-600mg
• 400-600mg every 4-6 hours
• 2400mg in short term use ( less than or equal to 3 days )